Multi-unit Assisted Housing with Services

North Carolina Health News reported that due to the high costs and restrictive nature of nursing home facilities, many seniors and people with disabilities are forced to seek care at the more affordable and unregulated Multi-unit Assisted Housing with Services, or MUAHS of Wilson County, NC.

These MUAHS are intended to act as independent living settings that allow residents the autonomy to manage their own finances, hire their own caregivers, and come and go as they please. However, the operations of MUAHS seem to be little different from those of prisons; reports to the Department of Social Services claim that residents with behavioral health conditions were being denied access to their finances, food stamps and personal medication.

In many instances, residents are found sleeping on bare mattresses on the floor, often living four or more to a room with no privacy. Generally, the Social Services Department receives about 30 complaints a month regarding abuse towards vulnerable adults. However, in the winter of 2021, they began to receive a surge in reports, with just one week receiving about 33 complaints. All of which stem from MUAHS.

Meanwhile, the operators of MUAHS profit immensely by taking the Social Security benefits of members and claiming any and all of member’s payments from the N.C.’s Special Assistance In-Home program. Although many skilled nursing facilities also offer deeply flawed care, the care provided at MUAHS somehow seems to be even worse.

In fact, on the weekend of August 12, 2023, one MUAHS operator even had the nerve to bring all 34 of their residents to the emergency department of the hospital, simply because he wanted to go out of town and would not be available to provide the single meal that he’s required to give the residents. Thus, he dropped them at the hospital so the hospital would provide them with meals. This left health care providers scrambling, as they only have the resources to treat about 3-4 patients with behavioral health issues a day, and every one of the MUAHS residents dropped at the ED had behavioral health issues.

When describing the event on August 12^th, Chris Munton, hospital CEO, expressed that this MUAHS operator’s act made the hospital unable to offer adequate care to those who actually lived in Wilson County and needed it. He went on to state that many MUAHS owners are found to be using hospitals as their own personal “holding stations” for their residents who may become “too aggressive or unstable,” as if MUAHS use the Emergency Department like a casual daycare.

This shocking behavior is less surprising when finding that most MUAHS are often run by the same individuals who run skilled nursing facilities. This is due to the fact that MUAHS are nearly robbing their clients of everything they have, making them extremely profitable (much like licensed facilities). Owners of licensed facilities are also better able to use their pre-established connections with residents who cannot afford their licensed facilities, and encourage them to move into their less-regulated facility. In both facilities the owner profits greatly, but MUAHS houses specifically allow owners to avoid the laws and oversight that may prevent them from further neglecting residents in a licensed care facility.

Gaps and loopholes in NC state law have allowed these MUAHS to persist. There is no regulation that requires them to allow routine inspections or monitoring like licensed facilities, and residents are not protected by the N.C.’s Care Home Bill of Rights. As Nichole Atkinson, the manager of the Social Security department’s Adult and Family Services program explained, “These homes have no oversight. No one is required to go in to make sure that they have proper zoning and proper construction, or that proper rules are in place. There’s no vetting of who owns or operates them.”

This has been the case since their existence was permitted in 2001 by the state’s General Assembly.

“This program was developed to be an alternative to more expensive, restrictive nursing home care, but with the lack of regulations and [no] licensing requirement, that has kind of opened the door for people that want to exploit our disabled and elderly,” stated Kimberly Irvine, director of Wilson County DSS.

Unfortunately, this lack of regulation ultimately grants owners nearly free rein to run MUAHS as neglectfully and greedily as possible.

As in many cases, the COVID-19 pandemic only exacerbated the situation, as the virus worsened the pre-existing mental health crisis, thus increasing demand for housing and care for those with disabilities. In fact, only 87 out of NC’s 141 registered MUAHS houses were operating before 2020. No MUAHS houses even existed in Wilson County before the wake of the pandemic. The county is now host to 14 of such houses, with many residents coming from out of state to reside there. The past five years of growth in this county exceeds the growth of MUAHS in any other county.

Yet many of these houses aren’t even registered, as the reprisal for running these houses without registration is miniscule to the operators. As Irvine explained, “Operating one of these facilities without being registered is the lowest misdemeanor with the lowest fine. [The owners] are going to pay the fine and continue to operate, so there really is no penalty.”

The situation has gotten so bad that local lawmakers are tiring of discussing MUAHS and are working to pass legislation to allow for at least some state oversight. In 2024, Dante Pittman was elected to represent the district that covers Wilson County in the state’s House of Representatives and recently filed a bill drafted to offer some regulation of MUAHS houses. He explained that while he acknowledges the need for housing that MUAHS may fill, “there’s got to be a basic human standard that’s part of this solution.” He even goes as far as to warn that it’s only a matter of time before this issue spreads outside of Wilson County. “If it can happen here, it can happen anywhere,” he adds.

Meanwhile, State Representative Sarah Crawford believes the bill provides so little regulation that MUAHS operators will essentially be unaffected. She says the bill may cause operators to file some additional paperwork, but this burden is expected to be “very minimal.” She adds that, “If they’re doing the right thing, they shouldn’t have any fear, but we need to have a process for getting bad actors either out of the business or helping them make reformation so that they can provide better care.”

Regardless, the bill has not gained enough traction to progress into law.

While it may be refreshing to know that policy-makers are at least attempting to address the tremendous issue of vulnerable-adult abuse, it’s a shame that licensed facilities have gotten so expensive and the care so low-quality that countless individuals with cognitive disabilities are willingly accepting care from these prison-like facilities. Ultimately, MUAHS are simply another example of the deceptiveness, greed, and negligence that penetrate the entire system of care for vulnerable adults in the U.S.